TNB 1 Introduction To Bioethics 2

Introduction
to Bioethics
School of Nursing
San Pedro College
Human Existence
• Born without his knowledge and
usually dies against his will
(Fromm, 1967)
• At moment of birth, one begins

to suffer and continues to suffer
until he dies
Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Human Existence
• Being born is a tragic fate à one
can feel an apparent absurdity in
one’s existence
• Every individual realizes life is a

disturbing question rather than
an answer in itself

Human Existence
• Life poses a big problem and
demands a corresponding
answer
• Leads individuals to search for

the ultimate meaning of life

Philosophy
• Ceaseless, intellectual quest for
the existential import of life
• Search for meaning

Search for Meaning
• Problems of:
• Reasoning (logical)
• Morality (ethical)
• Truth (epistemological)
• God (theological)

Search for Meaning
• Problems of:
• Art and Beauty (aesthetical)
• Cosmological (universe)
• Scientific (science)

Ethics

Ethics
• Refers to the individual’s search
for meaning
• Also known as moral philosophy

Morality

Morality
• Refers to the area of right and
wrong in the theory and practice
of human behavior
• Studies if human acts are good

or bad (right or wrong)

Moral Philosophy

Moral Philosophy
• Practical and normative science
• Based on reason
• Studies human acts
• Provides norms for goodness

and badness

Moral Philosophy as a Practical Science
• Systematized body of knowledge
that can be used, practiced, and
applied to human action
• Considers usefulness,
practicality, and application of
human knowledge to one’s
experience

Moral Philosophy as a Practical Science
• Distinguished from theoretical
knowledge à interested only in
truth for truth’s sake
• Not on the bearing on action and

experience

Moral Philosophy as Normative Science
• Establishes norms or standards
for the direction and regulation
of human actions

Big Questions in Ethics
• How can one determine whether
one is acting rightly or wrongly?
• Is there a norm of good and evil?

Basis on Reason

Ethics is Based on Reason
• All proofs of ethical science must
find their source in the native
power of reason alone
• Investigates facts, analyzes

them, and draws practical
applications to particular actions

Ethics is Based on Reason
• Does not rely on divine revelation
• Knowledge revealed to man by God
• Cannot be fully understood
• But need to be accepted as true

(because God says so)
• God cannot deceive nor be deceived

by us

This Separates Ethics from Religion
• Religion à no morality without
God
• Ethics à morality remains

possible without God
• Non-believers can still be good
• Believers can still be bad

Can Morality Exist without God?
Share your opinion.

Human Acts vs Acts of Man

Human Acts
• Acts à deeds
• Done with intellectual

deliberation and freedom

Human Acts
• Personal responsibility
presupposes knowledge and
volition
• Acts of irrational animals and the

insane are devoid of moral
significance
• Amoral beings performing non-

moral acts

Human Acts
• Done with knowledge and full
consent of the will
• One knows what one is doing

and does it freely and willingly

Acts of Man
• Performed in the absence of
either or both of the two
conditions (of the human act)
• Knowledge
• Free will

Case Example: Rape
• Rapist knows what he is doing and
does it with volition
• Quality of the act (rape) changes if

the rapist is an idiot or insane
• Rape victim suffers from an act of

man (insane/idiot) unless
predisposed himself/herself in a
sexually provocative manner à
becomes voluntary

Case Example: Rape
• Rape victim suffers from an act
of man (insane/idiot)
• unless predisposed himself/herself

in a sexually provocative manner
à becomes voluntary

Case Example: Rape
• Rapist is held morally
responsible for the sexual
assault (rape victim is not)

Ignorance

Ignorance
• Absence of knowledge in an
individual who is supposed to
know
• Should a person be held

responsible morally for an act
performed in ignorance?

Ignorance
• Types:
• Vincible – can be overcome by

exerting some effort
• Invincible – cannot be removed

even if there was extra effort

Case Example: Absence
• Student doesn’t know about a
test to be given tomorrow.
• Absent previous meeting but did

not contact classmates.
• Absent previous meeting but

could not contact classmates in
any possible way.

Health Ethics

Health Ethics
• Science that deals with the study
of the morality of human
conduct concerning health and
health care

Biology
• Study of life
• Science that employs the

scientific method to study living
things

Bioethics
• Ethics of life (or medical care)
• Division of ethics that relates to

the human life or the ethics of
the life sciences and health care,
both delivery and research

Scope of Bioethics
• Initial Stage:
• Ethical problems associated with

medical practice

Scope of Bioethics
• Later Stage:
• Expanded to include social issues

related to health, animal welfare,
and environmental concerns

Stages of Human Issues and Queries
• Beginning of life - contraception,
and family planning
• Middle of life – genetic

engineering and abortion
• End of life – death and

euthanasia

Evolution of Bioethical Studies

• even the most primitive tribes have a code (or set of unwritten rules)
in relation to one another
• human beings are social individuals who live with other individuals
• Family, Cave, and State

Human Beings are Social Individuals
• Family
• member lives, plays, and eats with

other members

• Cave
• dweller who lives, grows, and

hunts other animals with other
dwellers

• State
• citizen who exists, works, and

associates with other citizens

Purpose of the Code of Behavior
• certain situations bring rights
and obligations (toward each
other)
• needed to maintain peaceful and

well-ordered relations among
the members of the group
• for own survival

Purpose of the Code of Behavior
• system members are supposed
to treat themselves and relate to
each other (known as group
morality)
• without which, group will perish

Perforce of Morality
• grows out of human
relationships for the sake of
survival
• holds true for different

relationships
• physician-patient, teacher-
student, labor-management
(employer-employee) relations

1. Medical Ethics
• Oldest phase of bioethical

exploration
• Formulation of ethical norms for

the conduct of healthcare
professionals in the treatment of
patients

1. Medical Ethics
• based on the physician-patient

relationship (no different from
other human relationships which
involve duties and rights)
• respect for these rights and acting

by one’s duties --> good for both
parties (detrimental if any
infractions are committed)

Can We Date Our Patients?

Hippocratic Oath
• I swear by Apollo the Healer, by Aesculapius, by Health and all the powers
of healing and to call witness all the gods and goddesses that I may keep
this oath and promise to the best of my ability and judgment.
• I will pay the same respect to my master in the science as to my parents

and share my life with him and pay all my debts to him. I will regard his
sons as my brothers and teach them the science, if they desire to learn it,
without fee or contract.
• I will hand on precepts, lectures and all other learning to my sons, to those
of my master and to those pupils duly appointed and sworn and to none
other.

Hippocratic Oath
• I will use my power to help the sick to the best of my ability and
judgment. I will abstain from harming or wrong doing any man by it. I
will not give a fatal draught to anyone if I am asked, nor will I suggest
any such thing.
• Neither will I give a woman means to procure an abortion. I will be

chaste and religious in my life and in my practice. I will not cut, even
for the stone, but I will leave such procedures to the practitioners of
that craft. Whenever I go into a house I will go to help the sick and
never with the intention of doing harm or injury.

Hippocratic Oath
• I will not abuse my position to indulge in sexual contacts with the
bodies of women or of men whether they be freemen or slaves.
• Whatever I see or hear, whether professionally or privately which

ought not to be divulged I will keep secret and tell no one. If
therefore, I observe this oath and do not violate it, may I prosper both
in my life and in my profession, earning good repute among all men
for all time.
• If I transgress and foreswear this oath, may my lot be otherwise.

Hippocratic Oath
• No prescription of fatal drugs
• Rule out any form of abortifacient
• No sexual relations between

doctors and patients
• Moral significance of
confidentiality or medical secrecy

2. Research Ethics
• Second phase of bioethical studies
• Use of humans as experimental

specimens (biomedical research
• Prisoners, poor patients, children,

fetuses, non-consenting
concentration camp prisoners for the
production of “super offspring”
(Nazis, 1945)

2. Research Ethics
• led to the concept of informed

consent

Friedrich Nietsche (Third Reich Era)
• “superman” philosopher who
strengthened Hitler’s conviction of
the super race (“Aryans”)
• “will to power” driving force in

humans (or self-determination)
• progress is achieved not be

alleviation of the poor (but my
cultivating the superior race of
humans)
Sterilization is Liberation (Not a
Punishment)
• Eugenics (racial improvement
and planned breeding) poster in
1930s
• handicapped children
• “Who would want to be

responsible for this?”

Nuremberg Code (1947)
• Humanize the cruel and barbaric
nature of experiments
• Considers experiment’s subject’s

consent (informed
choice/decision)

Nuremberg Code (1947)
• Contributions:
• Respect of patient’s rights through

informed consent
• Right of patients to decline (not

submit himself to any healthcare
procedure)

Nuremberg Code
1. The voluntary consent of the human subject is absolutely essential.
• should have legal capacity to give consent; exercise free power of choice, without the
intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior
form of constraint or coercion; and should have sufficient knowledge and comprehension of
the elements of the subject matter involved as to enable him to make an understanding and
enlightened decision.
• This latter element requires that before the acceptance of an affirmative decision by the
experimental subject there should be made known to him the nature, duration, and purpose
of the experiment; the method and means by which it is to be conducted; all inconveniences
and hazards reasonably to be expected; and the effects upon his health or person which may
possibly come from his participation in the experiment.
• The duty and responsibility for ascertaining the quality of the consent rests upon each
individual who initiates, directs, or engages in the experiment. It is a personal duty and
responsibility which may not be delegated to another with impunity.

Nuremberg Code
2. The experiment should be such as to yield fruitful results for the
good of society, unprocurable by other methods or means of study,
and not random and unnecessary in nature.
3. The experiment should be so designed and based on the results of
animal experimentation and a knowledge of the natural history of
the disease or other problem under study that the anticipated
results will justify the performance of the experiment.
4. The experiment should be so conducted as to avoid all unnecessary
physical and mental suffering and injury.

Nuremberg Code
5. No experiment should be conducted where there is an a
priori reason to believe that death or disabling injury will occur;
except, perhaps, in those experiments where the experimental
physicians also serve as subjects.
6. The degree of risk to be taken should never exceed that determined
by the humanitarian importance of the problem to be solved by the
experiment.
7. Proper preparations should be made and adequate facilities
provided to protect the experimental subject against even remote
possibilities of injury, disability, or death.

Nuremberg Code
8. The experiment should be conducted only by scientifically qualified
persons. The highest degree of skill and care should be required through
all stages of the experiment of those who conduct or engage in the
experiment.
9. During the course of the experiment the human subject should be at
liberty to bring the experiment to an end if he has reached the physical
or mental state where continuation of the experiment seems to him to
be impossible.
10. During the course of the experiment the scientist in charge must be
prepared to terminate the experiment at any stage, if he has probable
cause to believe, in the exercise of the good faith, superior skill and
careful judgment required of him that a continuation of the experiment
is likely to result in injury, disability, or death to the experimental subject.

3. Public Policy
• Emphasizes participatory aspect of

decision-making in a democratic
setup with regards to formulation
of public policies
• Consulting people, seeking expert

opinions, and public discussion is
encouraged

3. Public Policy
• after proposals become law, are

further subjected to analysis and
evaluation by experts (for final
amendments)
• family planning, abortion, divorce,

use of life support machines, drug
testing on humans

Thank you.

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Introduction

• At moment of birth, one begins

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Every individual realizes life is a

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Leads individuals to search for

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Search for meaning

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Art and Beauty (aesthetical)

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Also known as moral philosophy

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Studies if human acts are good

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Studies human acts

• Provides norms for goodness

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Not on the bearing on action and

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Is there a norm of good and evil?

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Investigates facts, analyzes

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Knowledge revealed to man by God

• Cannot be fully understood

• But need to be accepted as true

• God cannot deceive nor be deceived

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Ethics à morality remains

• Non-believers can still be good

• Believers can still be bad

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Done with intellectual

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Acts of irrational animals and the

• Amoral beings performing non-

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• One knows what one is doing

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Quality of the act (rape) changes if

• Rape victim suffers from an act of

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• unless predisposed himself/herself

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Should a person be held

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Vincible – can be overcome by

• Invincible – cannot be removed

Copyright: Terro Nikko M. Baluyut, RN, CRN, MD

• Absent previous meeting but did